$70 machine claims to be "nurse;" background check underway

March 31, 2006 -- Today the web site of Wis10 (the Columbia, SC, NBC affiliate) posted an item by Chantelle Janelle with the headline: "Health Alert: Electronic nurse." The piece describes a $70 machine used by Montefiore Medical Center (Bronx, NY) to help real nurses do home health monitoring by asking patients basic questions about their conditions. The item is an example of the sad tendency of some promoters of electronic health equipment, and the media that covers them, to call such machines "nurses." Of course, these machines do some very basic things that nurses or those assisting them might otherwise do. But they are no more "nurses" than surgical robots are surgeons. We have yet to hear of any robot that handles surgical tools or utters pre-programmed questions being called an "electronic physician." Calling such a machine a "nurse" shows disrespect for nurses' years of college-level training. And it reinforces the damaging view that nurses basically serve as mechanical conduits between patients and physicians.

The piece points to the increasing role of digital technology in modern life, then refers to the nursing shortage, and notes: "Put the two together and you get an electronic nurse." Then it describes what the machine does for heart patient Mary Bowers. She steps on the scale and it tells her she is below her "maximum allowed weight." It "asks Bowers questions like, 'Are your ankles or feet more swollen? Does your stomach feel more bloated? Are you urinating more than usual?'" The machine stays "on top of lots of warning signs and symptoms, something a nurse would often have to do." Nurses are "still involved," but in a more "efficient" way. The information from Bowers's "electronic checkup" is transmitted to Montefiore's home health agency, where a nurse reviews it. The piece notes that if there are "any red flags," the "live nurse" calls Bowers "and, if needed, consults the doctor." There is no discussion of whether this nurse would be exercising any professional judgment in detecting and responding to the "red flags."

The piece also has a few quotes from Montefiore's Pamela Joacham, who explains that the machine "supplements" patients' visits to the hospital, and that it makes a difference: "There is a very much decrease [sic] in emergency visits, re-hospitalizations[,] even physician visits. We get it early on so those visits are really decreased tremendously." The piece notes that the machine "costs about $70 depending on features and which vital signs you're monitoring." The hospital is now paying for it, but hopes to "get insurance companies to foot the bill." There is no discussion of any operational glitches or the possible consequences, the potential cost savings of the machine, or the extent to which such machines might ease nursing workloads.

Obviously technology like this machine may provide important health benefits, and may even help nurses practice more efficiently. But labeling a $70 care tool a "nurse" is inaccurate and offensive. Nursing requires years of college-level training, and it involves a wide range of critical judgments and actions that no machine can do. Shall we start calling stethoscopes "sonic nurses?" It's no accident that we have seen no press accounts of new health technologies called "electronic physicians." Physicians might respond aggressively to such a product name, noting (correctly) that no patient should be encouraged to rely on some machine to provide the range of highly skilled care that they provide. Moreover, nurses continue to suffer from the common perception that their job is essentially to act as a mechanical conduit between patients and physicians. Suggesting that an inexpensive machine can do their jobs, or even much of their jobs, reinforces this impression and contributes to the devaluation of the profession.

At least in some states, if any human without a nursing license claimed to be a "nurse," he or she would likely be in violation of state law forbidding such statements by those who are not in fact nurses. Ironically, recent New York press stories about minimally trained "baby nurses" have noted that "nurse" is not yet a protected title in that state, and suggested that patients may suffer as a result [link].

We urge you to let Montefiore Medical Center know that its machine may be helpful, but it is not a "nurse," and continuing to promote the product that way shows disrespect to its own nursing staff.

We have contacted Montefiore Medical Center's PR person, Steven Osborne, as well as the nurse and physician in charge of the hospital's home health program. We hope that we have gotten the message through, but if you see any further instances of Montefiore promoting its machine as a "nurse," please call Steven Osborne at (718) 920-4011, or email him at sosborne@montefiore.org and copy us at letters@truthaboutnursing.org. Thank you.

You can see the Wis10 article and various others using "nurse" in their headlines at News 5, News 8 Austin, and News 14 Charlotte.